CMS proposed a rule July 2 that would revise Medicare payment rates for HOPDs and ASCs starting in 2027.
Here are five things ASC leaders need to know.
1. More surgeries will shift to ASCs. The rule proposes continuing to phase out the inpatient-only list and expanding the ASC Covered Procedures List, giving physicians more flexibility to choose the lowest-cost clinically appropriate setting for surgery.
2. Site-neutral imaging payments are coming. CMS proposes equalizing payment rates between physician offices and off-campus hospital outpatient departments for imaging services such as X-rays and MRIs. The change would cut Medicare Part B spending by an estimated $260 million in the first year, including $70 million in beneficiary savings.
3. 340B drug payments would be tied to actual acquisition costs. CMS proposes aligning 340B Drug Pricing Program payments with what hospitals actually pay for the drugs, projecting $5.7 billion in combined savings for Medicare beneficiaries and taxpayers in 2027.
4. Botulinum toxin injections face new scrutiny. CMS cited a 42.8% surge in claim volume for the procedure between 2017 and 2024 and proposed adding utilization management requirements, projecting more than $17 million in annual savings.
5. Price transparency rules could get an overhaul. CMS issued a request for information seeking public input on standardizing hospital price transparency data formats.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.